13 May 2009

Congressional leaders are looking at accelerating the schedule on health care reform legislation. Why?Should the House meet its July 31 deadline, Senate Republicans would be under intense pressure to vote for a negotiated health care compromise or see Senate Democrats tackle the overhaul under the budget reconciliation instructions that would make it immune to filibuster in the Senate.

This is good. The House bill will almost certainly have some version of the public plan. The Senate debate will take place with that fact established, which may, we hope, embolden moderate Dems into holding out for a fair public option.

Sen. Ben Nelson announced at the beginning of this month that he opposed the creation of a public health care plan that people would have the option to buy into. He'd be gathering together a coalition of like-minded senators to oppose the plan, the conservative Democrat from Nebraska promised.

More than two weeks later, it's still a coalition of one.

Good. As supporters of real reform are rallying, moderates are wary of being left out of the process. Moreover, they'd rather be on the winning team than take the risk of trying to broker an unpopular compromise that might not even be necessary. Open Left now reports that there are 51 Senators open to the possibility of a public option.

In 2009, after much of the rhetoric on last year's campaign trail focused on the growing ranks of the uninsured, the major thrust of health-care reform centers on something that affects everyone: the staggering cost of a system that threatens to devour the rest of the economy.

Karen Tumulty points out that the need to greatly expanded, if not universal coverage has been accepted by just about everybody and is no longer even a matter for debate. The goal of "bending the cost curve," however, remains elusive. The WSJ looks at a few different mechanisms for funding this expansion of coverage:

Higher taxes on alcohol and tobaccoPros: These taxes, a popular way to pay for insurance expansion (see: Schip), also do “double duty” by reducing use of products that harm health.Cons: They raise only “modest” amounts of funds unless the taxes are hiked so much as to be politically unpalatable.

Taxes on employer-sponsored health insurancePros: The government gives up some $246 billion a year in income and payroll taxes that could come from taxing health benefits, Oberlander says. Capping this tax exclusion could bring in substantial amounts of money. The idea is getting some real consideration in Congress, WSJ reports.Cons: The idea is very controversial, and would be difficult for Obama politically, since he would be reversing course after opposing such a proposal from John McCain during the campaign. Employees in expensive insurance pools (such as companies with older workers) might also be unfairly penalized.

Employer mandatesPros: Requiring employers to either provide coverage to their workers or pay a tax would build on the current employer-based system. This would be a political advantage, Oberlander notes.Cons: If small businesses are exempted, as has been suggested, this won’t bring in as much money as it otherwise would.Individual mandatesPros: It’s possible to get bipartisan agreement on these, especially since the insurance industry believes requiring people to get coverage is a key step toward avoiding coverage rules that limit benefits for sicker patients.Cons: Taxing people who don’t obtain coverage would be controversial. And many of the uninsured have low incomes and would require government subsidies.

It's worth noting that these are not the only options on the table, and it's a given that some sort of individual mandate will be included, as will some sort of pay-or-play for employers. I've heard some rumblings that Obama's proposal to limit certain itemized deductions for higher-income taxpayers may not be entirely dead. This may be the most challenging part of reform; while we all obsess over the Public Plan option, the financing will make or break the ability of any final package to receive Congressional approval.

You'd think that doing research to figure out which treatments are most effective would be an obviously good thing. But no: it is, apparently, the first step on the road to socialized medicine. A lot of the attacks rely on this "first step" argument. For instance, the Heritage Foundation wrote that "The type of information collected by CER could eventually be used inappropriately if a "Federal Health Board" was created to decide which types of treatment would be available to whom and when."

It could be used to do bad things! At least, if a board that doesn't exist were created and told to use this information! Pass me my smelling salts.

It's worth pointing out that the Swiftboaters over at Conservatives for Patients' Rights are already seizing on this in their ads. It's not as catchy as the Harry and Louise ads, nor as scary, because it's kind of complicated. But it's no less shameless in its dishonesty and scaremongering. But when FUD is all you have, you gotta ride that horse...

One interesting thing worth noting is although conservatives insist as an article of faith that Obama secretly intends to impose a single-payer plan on the nation, the single-payer advocates have been completely shut out of negotiations at all levels, and they're hopping mad about it:Daily Kos: Can No One Rid Us of These Single-Payer Advocates?

The powers-that-be are not even going to publicly discuss single-payer. Despite the immensity of the issue, there will be no three-day, televised hearing devoted to witnesses discussing single-payer's pros and cons in full public view. Instead, the whole single-payer idea is being treated as if it were a terrorist. They've shackled it, put a hood on it, renditioned it and disappeared it.

- Most progressives, and many millions of Americans, support the concept of a single-payer health care system.

- Those in Congress, like Sen. Max Baucus (D-MT), who refuse to consider single payer in the debate over health care are the enemies of single payer.

[P]rofessional advocates of single payer seem to believe their biggestenemies are those who support single payer, but short of that, wouldalso support a robust public option in a non-single payer universalsystem.

Sirota's point is that if single-payer advocates who are reasonable and open to compromise were included in the debate, they could be positive advocates for reform, but reasonable single-payer advocates tend to be in short supply. The fervor, dogmatism and tactics of the single payer zealots serves only to ensure that they are not taken seriously and that their enthusiasm will go to waste. Pity.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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